Surgical disorders of the urinary tract/umbilicus

Question 1

A foal presents with biochemistry showing hyperkalaemia, hyponatraemia, hypochloraemia, dehydration and acidosis. What is your most likely diagnosis?

Answer 1

Ruptured bladder

Question 2

Is a ruptured bladder a medical or surgical emergency?

Answer 2

Medical - must stabilise potassium levels before surgery as can cause fatal arrhythmias

Question 3

Hyperkalaemia must be corrected before inducing a foal to repair a ruptured bladder. What must potassium be below?

Answer 3

<5.5mg/L

Question 4

What fluid therapy can be given to correct a foal with a ruptured bladder?

Answer 4

Sodium bicarbonate - for acidosis
Calcium borogluconate - for hyperkalaemia (raises resting potentials)
Insulin (or glucose as this leads to insulin - drives potassium into cells)

Question 5

How should you stabilise a foal prior to ruptured bladder repair?

Answer 5

Fluid therapy
Drain abdomen slowly - improves ventilation, decreases K
Antibiotics
Check IgG status

Question 6

A foal with a ruptured bladder can be surgically repaired via which approach? What can be done at the same time?

Answer 6

Midline laparotomy

+/- resection of umbilicus and urachus

Question 7

What sex horses are prone to uroliths and which type are they usually in horses?

Answer 7

Males
Calcium carbonate (type 1 or 2)

Question 8

How is urolithiasis treated in horses?

Answer 8

Surgical removal - laparotomy, laporoscopy

Electrohydraulic/laser lithotripsy

Question 9

Sabulous cystitis is a problem secondary to bladder paralysis or other neuro disorders that prevent the bladder emptying. What does sabulous mean?

Answer 9

Sandy, gritty

Question 10

What is a treatment option for a horse with unilateral renal neoplasia or non-antibiotic-responsive pyelonephritis?

Answer 10

Nephrectomy

Question 11

What is the treatment for a patent urachus?

Answer 11

Check for concurrent septicaemia/septic arthritis or physitis
Medical treatment - antibiotics, topical cauterising agents
Surgical - resect urachus
Often self-resolving

Question 12

Patent urachuses are often self-resolving but can be treated surgically or medically. Medical treatment involves antibiotics and topical cauterising agents. Name some topical cauterising agents

Answer 12

Concentrated phenol or iodine

Silver nitrate

Question 13

A 1 week old foal presents depressed and off suck with a swollen, painful umbilicus. What is your top differential and how would you confirm this?

Answer 13

Umbilical sepsis

Ultrasound

Question 14

What is the treatment for umbilical sepsis in foals?

Answer 14

Blood culture, haematology, biochem
Assess for IgG and concurrent septicaemia/artritis/physitis
Systemic antibiotics +/- surgery

Question 15

When should umbilical hernias be surgically repaired (rather than leaving to self-resolve)? 3 reasons

Answer 15

If large and persists >6 months of age
If defect increases in size
If causing colic